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                    D e n t a l    F o l l i c l e               

             The        Monthly     E-newsletter                   Vol - I                                 June-2006

In this Issue:

Editorial :

       We @ www.DentistryUnited.Com are pleased to bring you the first edition of our monthly E-newsLetter , Dental Follicle This is the first E-Newsletter of its kind where in ,we have a space to every reader . You can publish your cases here , send in a joke or thought of the month .We will also have  a section "The Future Dentist" where in you will send in your pic with your reason for selecting Dentistry as your career.We will be also introducing a discussion panel linked to the newsletter which will help each one of us share our knowledge with dentists across the globe!

        As you are reading this E-Newsletter , there a many many many dentists across the globe who are reading Dental Follicle with You on their computer screens.

       Your comments , feedback and involvement will only help us improve! Please send your feedback with your name,qualification ,location to info@dentistryunited.com

Yours truly

Dr.Nabeel S

Editor

Editor - Dental Follicle and webmaster www.DentistryUnited.com

News :

Publication :

  1. Evaluation of individualized homeopathic remedies on trigeminal neuralgia treatment

  2. Snatch the Opportunity and the Job

Laughter The Best Medicine :

A husband and wife entered the dentist's office. The husband said, "I want a tooth pulled. I don't want gas or Novocain because I'm in a terrible hurry. Just pull the tooth as quickly as possible."

"You're a brave man," said the dentist. "Now, show me which tooth it is."

The husband turns to his wife and says, "Open your mouth and show the dentist which tooth it is, dear."
 

Thought for the Month:    The abutment teeth should have a combined pericemental area equal to or greater in pericemental area than the tooth or teeth to be replaced - {Ante's Law}

 

 

Evaluation of individualized homeopathic remedies on trigeminal neuralgia treatment

-Yalda Nozad Mojaver DDS, MS       Assistant professor, Department of oral medicine, The university of  Rafsanjan School of Dental Medicine, Rafsanjan, IRAN -     Member of Iranian Homeopathy Association -Fahimeh mosavi D.D.S ,M.S (  Associate professor, Department of oral medicine, The university of Tehran  School of Dental Medicine, Tehran, IRAN     Member of Iranian Homeopathy Association) -Ali Mazaherinezhad M.D (  Member of Iranian Homeopathy Association (IHA)  - Ardavan Shahrdar M.D   Chairman of Iranian Homeopathy Association (IHA) The corresponding author:-Yalda Nozad Mojaver     

 

Objective: To assess the efficacy of individualized classical homeopathy in the treatment of Idiopathic Trigeminal Neuralgia (ITN) 

Method: This study was a homeopathic (look & see ). 15 patients with physician-confirmation trigeminal neuralgia (mean age 55.9 women & 61.6 men & female/male =2/1 ) were treated with  homeopathic method. patients received oral  liquid  C 30 once per month and were fallowed in the end of 1st, 2nd ,3rd  and 4th  month . “ Visual analogue scale “ was used for the evaluation of pain intensity and descriptive criteria were used for evaluation attack frequency.

 Result: All the 15 cases completed the treatment protocol. There were statistically significant improvements in both pain intensity and pain attack frequency in the 4-month follow up (p <0.001). Pain intensity improved for more than 60% after four months of treatment. 

Conclusion: Our result suggest that homeopathic treatment is an effective and safe method in the treatment of Idiopathic Trigeminal Neuralgia

 Keyword: Trigeminal neuralgia, Homeopathy, pain

 

Introduction:

 Currently there is an increasing interest to apply homeopathy as a complementary medical treatment for a wide range of acute and chronic conditions is increasing[1],[2]. Acceptable levels of patient satisfaction with homeopathic care have been reported[3]. Clinicians have reported the benefits of individualized constitutional homeopathic remedies in improving of chronic pains3. Trigeminal neuralgia (TN) is a chronic pain with paroxysmal and radiating presentation. T.N is often uni-lateral and has trigger zone in involved area. TN Patients often describe the pain attack as a “red hot needle” or “forked lightning” pain in their face.  The French term “tic doloreux” emphasizes the sudden onset of pain that may be triggered by touch or cold. The etiology of T.N  is unclear but there are some evidences that it can be caused by Herpes simplex [4] ,arteriovenous malformation [5],intra cranial tumors [6] ,  metastasis of some tumor[7] , Multiple Sclerosis(M.S) [8] and the most important: compression of the trigeminal nerve root , near to its entry into the pons , by an aberrant arterial or venous loop [9]. But since the etiology of many  cases is unknown  ,standard first line treatment is Carbamazepine[10] . Other drugs including lamotrigine [11],phenytoin [12],gabapentine [13],oxcarbazepine [14],topiramate [15],baclofen [16], and clonazepam[17] have some effect .Many patients fail to have a permanent response to drug. “ Non-drug” options for such patients include microvascular decompression [18], neurectomy [19], radiofrequency [20], thermal ablation [21],glycerol injection [22],cryosurgery [23], and low level laser therapy [24]  .TN affects 4 to 5 persons in 100000  and Females are affected more than males[25]. The pain tends to be more frequent in the right side  (60%)[26] and in elder people ( 6th and 7th decade)[27]  . we didn’t find any documented study about effect of homeopathic remedies on trigeminal neuralgia treatment. The purpose of this study was to evaluate of efficacy of homeopathic treatment in ITN patients

 

Material and Methods

  Cases

An experimental, prospective, look & see study  was implemented. Since the trigeminal neuralgia is a rare condition(prevalence: 4-5/100000)

 Inclusion criteria :15 patients with essential TN referred to both Oral Medicine Clinic and Neurology Clinic of Emam khomeiny Hospital of Tehran University from March 2002 to March 2004, were included in this study.

  The overall mean age of cases were 58.7 years old (55.9 years old for women & 61.6 years old for men) and female/ male ratio was 10/5. . All cases were confirmed by physicians and had failed to response to previous medical therapy.

Exclusion criteria: The patients with a history of alcohol or drug abuse  and current narcotic analgesic were excluded from the study to minimize psycho physiological confounding. Also to  prevent cross action  Homeopathy and allopathic drug cases could not have a systemic immunosuppressive therapy in past  history and before patients start the treatment protocol  , they stopped allopathic drug therapy( with neurologist   confirmation )at least 24 hours before enrollment

Method:

A study(look & see) was implemented.Since TN pain attacks are always sever in quality, treatment with placebo (Control group) was not possible because of ethical problems. Patients had homeopathic visits at baseline, and the end of 1st   , 2nd    , 3rd   and 4th month. They were evaluated with “visual analogue scale” for pain intensity[28]. Since frequency of pain attacks varies considerably among affected patients, below mentioned descriptive criteria were applied for comparison purposes.

Descriptive criteria for scoring pain frequency:

-         0-5/day = mild 

-         6-10/day = moderate

-         11-15/day= severe

-         >15/day=very severe

 

The descriptive criteria for pain frequency .Both of them (pain frequency and pain intensity ) were evaluated in each visit.

All patients at the baseline enrollment and 4 month follow up told to homeopath about pain frequency in the day before interview. All of the participated homeopaths had similar training in classical homeopathy and at least 5 years of practical experience.

 Homeopaths must choose one from over 1300 different possible remedies in the homeopathic pharmacopoeia of United States (www.hpus.com). Though typically supported now by computer software programs to assist in narrowing the choices .  

In a review of previous clinical trials, European Commission Homeopathic Medical Research Group consensus panel has remarked a methodological concern in selecting inappropriate homeopathic remedies in the reviewed studies, especially in short-term study. Two experienced medical homeopaths jointly interviewed individual patients in each visit and made a common decision on the appropriate remedy selection with a confidence rating of at least 7 out of 10 for the patient to enroll.

After case-taking  patients received  diluted liquid remedy  globule  C30 in 4 oz water monthly, 1 dose at the baseline and if it was necessary , 1 dose at  the end of 1st ,2nd ,3rd ,4th  month .

 

 Ethical consideration:

The study plan had been approved by the joint ethical committee of Tehran University.  Ethical considerations precluded requiring patients to be completely drug free for the study.

 

Statistical analyses :

Friedman test for evaluating homeopathic treatment effects during follow up period was implemented .Wilcoxon Matched-Paired Rank test was applied to assess the effects of homeopathic treatment planning during 4 month.

SPSS (Version 11.5) was used for data analysis.

 

Results:

   15 cases completed the study protocol .No adverse drug reaction to a treatment solution was reported as a reason for leaving the study. Table 1 summarizes the results of Friedman test for reported pain intensity and pain frequency in all of patients during 4 months. There was an statistical significant reduction in pain intensity  and pain frequency.(p<0.001)

Figure 1 shows the homeopathic remedies were approved for men or women group and according to this figure the most women matched with “Puls” and the men matched with “ Acon” .

Wilcoxon Matched-Paired Singed Rank Test was done for evaluation of homeopathic treatment planning protocol. This test evaluated the effect of homeopathic treatment at the baseline and final visit and finally showed the time of significant changes. (Table 3)

As described in table 3, reduction of pain intensity in all patients during all visits was significant, and reduction of pain frequency except in comparison between 3rd and 4th visits in all patients during all visits was significant.     (p< 0.05 )

 

 

Discussion

 

The finding demonstrates that individualized homeopathy can reduce pain intensity and pain frequency.

This is the first –but small- clinical trial study in which homeopathy performed in treating patients with trigeminal neuralgia. According to the lack of definitive conventional treatment for trigeminal neuralgia , the lack of  improvement in pain over the natural history of the condition and the high rate of utilization of complementary medicine by trigeminal neuralgia ,homeopathy emerges as a potentially low-risk ,evidence-based option in an integrated package of care . Homeopaths claim that patients need at least 1 month of active treatment for every year of illness .So the present sample would have require a 12-month, not a 3 to 4 month ,trial to assess optimal benefit .In order to  lack  of  documented study about individualized homeopathy in trigeminal neuralgia , we had to compare this study  with gold standard treatments  of trigeminal neuralgia .

The first line of ITN treatment is carbamazepine. Carbamazepine is a very old treatment and in patients without any side effects or resistance in the best condition remission rate is approximately 60%.26

 Remission rate about  Baclofen  is very different , Parmar  reported  a different remission  rate between 20-60%  in ITN treatment [29] In one study  Steado  showed  Baclofen  has a positive effect ,approximately 62%,  in treatment of trigeminal neuralgia [30].

Gabapentine and Lamotrigine are also  effective in  ITN treatment. C.Solaro demonstrated that combination therapy with Lamotrigine and Gabapentine are more effective than single therapy. Remission rate in this study estimated almost 70% ( dosage : up to 1200 mg ) [31]

Since all of the above study reported their results  by percent, therefore in comparison  we reported our results in percent too ,in other hand  all of studies  have evaluated only pain reduction .pain reduction in this study at the end of 1st month was 45.23% ,2nd month ; 53.49% , 3rd month ; 59.83% and finally at the end of 4th month was 62.79%.

Although a comparison between homeopathy treatment and medical therapy is not acceptable     ( due to differences in the types of treatments, the way of description , type of drugs, and finally in philosophy of cure ) but since lack of   homeopathy study about trigeminal neuralgia we had to do this dissimilar comparison . Any way medical therapy often has a different side effect and it is occasionally accompany with tolerance therefore in many cases we should use aggressive method such as neurectomy etc and in many cases after aggressive methods, unfortunately pain return.

This study didn’t has a control group ( for  ethical consideration ) and  the patients number was small therefore we shouldn’t sure that this study could be evaluated the complete effectiveness of homeopathic treatment but it was the first step and first step always needs support and a little ignore! 

Homeopathy is a safe and useful method in treatment of many diseases but for more reliability needs more and more researches…..

 

 

 References :

1 -  clover  Ann, Homeopathy  ,  UK ,  Victoria  , 1992 ,  p: 89-93

2-  Bell IR,  Improved  clinical status in fibromyalgia patient treated with individual homeopathic remedies versus placebo  .  Rheumatology , 2004 , 1 of 6

3-  Cucherat M . Evidence of clinical efficacy of Homeopathy (A Meta-analyses of clinical trial) .  Eur J  Clin Pharmacol  , 2005 ; 56: 27-33

4 -  Tenser RB , Trigeminal neuralgia , Mechanisms of treatment .  Neurology , 1998 ,Jul : 51 (1): 17-9

5- Lee SH ,  Levy EI,  Sacarrow AM, Kassam A ,  Janneta PJ , Recurrent trigeminal neuralgia attributable to veins after microvascular decompression . Neurology 2000, Feb ; 46(2) : 356-62

6- Tsurushima H, Kamezaki. ,Tomono Y, Nose T. Intracranial epidermoid cyst including elements of old hematoma . Neurol Med Chir Tokiyo 1997,  Nov ; 37(11):861-4

7-Hirota N .Isolated trigeminal nerves metastases from breast cancer . Surg Neurol .1998, May ; 49(5) : 558-61

8-  Gass A. Trigeminal neuralgia in patient with multiple sclerosis lesion localization with magnatic resonance imaging . Neurology. 1999 ,Oct ; 49(4) : 1149-4

 9-  Fujita N. Hirabuke N. Kashiwage N. Epidermoid tumor of the cerebellopontine angle .Signal loss in the contralateral cistern .AJNR Am J Neuro oncol ,1997, Mar; 32 (1) :87-90

10 -  Medline plus information : Carbamazepine (systemic)

       www.nlm.nih.gov/medlineplus/druginfo/uspd/202111/html

11 - Medline plus information : Lamotrigine

        www.nlm.nih.gov/medlineplus/druginfo/uspd/202786/html

12-  Medline plus information : phenytoin (oral)

         www.nlm.nih.gov/medlineplus/druginfo/uspd/a682022.html

13-   Medline plus information : Gabapentine

         www.nlm.nih.gov/medlineplus/druginfo/uspd/gabapentine.html

14-  Medline plus information : Oxacarbamazepine

         www.nlm.nih.gov/medlineplus/druginfo/uspd/oxacarbamazepine.html

15-  Medline plus information: Topramate

         www.nlm.nih.gov/medlineplus/druginfo/uspd/topramate.html

16-Medline plus information : Baclofen

         www.nlm.nih.gov/medlineplus/druginfo/uspd/baclofen. html

17-Medline plus information : Clonazepam

         www.nlm.nih.gov/medlineplus/druginfo/uspd/clonazepam. html

18-   Inoue T. Microvascular decompression for treatment of trigeminal neuralgia ,hemi facial spasm and glossopharyngial neuralgia three surgical approach variation. Neurology. 2003, Dec;53(6):1436-43

19-   Greenberg M. Glick. Burket’s oral medicine .10th edition. Spain ,BC Decker. .2003.chapter 11.p: 327-329

20-   Huang E. Gamma knife radio surgery for treatment of primary trigeminal neuralgia in multiple sclerosis patients .Stereotact Funct .Neurosutg.2002;79(1):44-50

21-   Methews ES. Percutaneous stereoactic radiofrequency thermal rhizotomy in the treatment of trigeminal neuralgia .Mt  Sinai J Med.2000 Sep;67(4):288-99

22-   Erdem E ,Alkan A. Peripheral glycerol injection in the treatment of idiopathic trigeminal neuralgia .J Oral Maxillofacial Surg .2001,Oct; 59(10) : 1176-80

23-   Pardel W. Cryosurgical treatment of genuine trigeminal neuralgia . Br J Oral Maxillofacial Surg.2002 .Jun ; 40(3) : 244-7

24-   Chemaly D,Perusse R. Low level laser therapy (LLLT) is an important tool to treat disorder  of maxillofacial region . J Clin Laser Med Surg .1998, Aug; 16(4): 223-6

25-   Goetz CG,Pappert EY. Textbook of clinical neurology.2nd ed. Philadelphia : Saunders;2004:155-170 

26-   Youman’s JR. Neurological Surgery. Vol 5. 5th ed. Philadelphia .Saunders ; 2002: 3376

27-   Kumar GK, Vartanian AJ,Alvi A, Kassam A, Jannetta PJ. What is facial pain trigeminal neuralgia? . Postgrad Med. 1998 Oct; 104(4): 149-51,155-6

 

28-   “Visual analogue scale”

 www.blackwellpublishing.com/ specialarticles/jcn_10_706.pdf

29-   Parmar BS. Baclofen  in trigeminal neuralgia : Clinical trial . Indian J Dent Res. 1998. Oct-Dec; 1(4): 109-13

30-    Steado L. Efficacy of Baclofen in trigeminal neuralgia and some of painful condition, A clinical study. Eur Neurol . 1984; 23(1) : 51-5

31-   Solaro C. Low dose Gabapentine combined with either Lamotrigine or carbamazepine can be useful therapies for trigeminal neuralgia in multiple sclerosis .Eur Neurology.2000; 44-48

 

 

Snatch the Opportunity and the Job

By - Cathy Warchaw

 

 

               Okay, you’ve submitted a killer resume. You’re ahead of the pack and have just received a call for an interview. What do you do next?

 

                The interview is the most stressful and important part of job hunting. This is where the employers make a decision based on his or her impression of whether to hire you for the position. You will want to do your best in this part because here lays the culmination of all your job hunting efforts. Flub it here and all your efforts from application to examinations will go down the drain.

 

1. Make a Great Impression

Always dress accordingly for the interview. Your outfit should be appropriate.  No matter what the style of dress may be for the employees show up looking the best you can be. First impressions for applicants should be professional attire.

 

2. Do a Little Research

One of the best ways to make a good impression on your interviewer is to do a little research on their business. This will equip you with material to answer many of the questions the interviewer will ask. One of the questions you will be asked is how your skills can benefit the practice. If you know a thing or two about the business, you will find it a lot easier to answer this question. Plus, dropping a few meaty tidbits about how much you know about their practice will go a long way in impressing the interviewer.

 

3. Watch Your Body Language

Many of the interviewers are well versed in body language.  You will find throughout the interview they will be looking for hints about your personality from the way you act, talk, and move. Avoid telling lies or embellishing your answers. Experienced interviewers will notice this in an instant. Always keep your palms open and avoid crossing your legs or your arms together. Do not be afraid to make eye contact while speaking; just make sure that you do not come across as intimidating.

 

4. Confidence

Walk in with a purpose. Answer with a purpose. Try not to be too self-conscious. Make sure you are confident in what you say. If you hit a snag and find yourself in a compromising situation, make sure you handle the situation confidently – even when saying that you do not know an answer to a question. Confidence reflects competence. Employers always look for competent people to fill the positions.

 

 

© Warschaw Learning Institute 2006

Cathy Warschaw is the Director of the Warschaw Learning Institute an online educational site offering; Dental Office Management Program, Telephone Training,  HIPAA and various e-books. For more information go to www.WarschawLearningInstitute.com or call (323) 822-0917(323) 822-0917.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


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